{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:51:11Z","timestamp":1790704271164,"version":"4.1.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>As the most abundant protein in plasma, albumin (ALB) presents close association with prognosis of septic patients. Whereas, the benefit and the target level of ALB infusion remain controversial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective investigation to assess whether on-treatment ALB levels could predict 28-day mortality and try to identify the optimal level for ALB infusion. All patients diagnosed as sepsis from January 2016 to December 2020 were recruited and re-evaluated using Sepsis-3 criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 199 eligible patients were enrolled in this study. Compared with the survival group, the non-survival group had more males (73.97 vs. 56.35%), older patients (62.78\u202f\u00b1\u202f15.93 vs. 56.43\u202f\u00b1\u202f18.46), and a higher proportion of Gram-positive bacterial infection (27.40 vs. 23.02%), higher Sequential Organ Failure Assessment (SOFA) score (7.00\u201313.00 vs. 6.00\u201312.00), higher APACHE II score (18.25\u201329.00 vs. 15.00\u201326.00), higher PCT (2.84\u201349.18 vs. 2.43\u201319.14), more patients with septic shock (65.75%vs. 43.65%), shorter ICU-stay days (11.04\u202f\u00b1\u202f6.28 vs. 14.83\u202f\u00b1\u202f8.58), longer mechanical ventilation days (7.23\u202f\u00b1\u202f7.07 vs. 5.04\u202f\u00b1\u202f8.52), with statistically significant differences (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.050). Furthermore, we identified that the ALB level on day 7 (HR, 0.920; 95% CI, 0.847 to 0.999; <jats:italic>p<\/jats:italic>\u202f=\u202f0.046) and the maximum ALB level within the first 14\u202fdays (HR, 0.900; 95% CI, 0.838 to 0.967; <jats:italic>p<\/jats:italic>\u202f=\u202f0.004) were independent protective factor for the 28-day prognosis in septic patients. Moreover, ROC curve analysis indicated that optimal target level for first 14-day maximum and on day 7 were 33.45\u202fg\/L and 27.85\u202fg\/L, respectively. Correspondingly, a negative correlation between ALB level and mortality was defined with Kaplan\u2013Meier survival curve analysis. Further subgroup analysis showed that the group with ALB above the cut-off value was associated with favorable outcomes in female patients under 60\u202fyears, with SOFA score less than 7, and APACHE II score less than 19.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ALB levels on day 7 and the maximum ALB level within first 14\u202fdays after ICU admission were closely associated with 28-day mortality. 27.85\u202fg\/L would work as the target level of ALB infusion on 7\u202fday to improve the prognosis of sepsis patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1490838","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T05:38:45Z","timestamp":1747201125000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["On-treatment serum albumin levels can predict 28-day mortality and guide albumin infusion in sepsis patients"],"prefix":"10.3389","volume":"12","author":[{"given":"Danfeng","family":"Ren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangyun","family":"Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianzhi","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwen","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ze","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taotao","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingren","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for Sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1097\/01.CCM.0000194725.48928.3A","article-title":"Sepsis in European intensive care units: results of the SOAP study","volume":"34","author":"Vincent","year":"2006","journal-title":"Crit Care Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s13054-023-04385-x","article-title":"National incidence and mortality of hospitalized sepsis in China","volume":"27","author":"Weng","year":"2023","journal-title":"Crit Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","article-title":"Assessment of global incidence and mortality of hospital-treated Sepsis. Current estimates and limitations","volume":"193","author":"Fleischmann","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jinf.2016.11.006","article-title":"Hospital-related cost of sepsis: a systematic review","volume":"74","author":"Arefian","year":"2017","journal-title":"J Infect"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"4648","DOI":"10.4049\/jimmunol.1201806","article-title":"Sepsis chronically in MARS: systemic cytokine responses are always mixed regardless of the outcome, magnitude, or phase of sepsis","volume":"189","author":"Osuchowski","year":"2012","journal-title":"J Immunol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s00281-017-0639-8","article-title":"Cytokine storm and sepsis disease pathogenesis","volume":"39","author":"Chousterman","year":"2017","journal-title":"Semin Immunopathol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1089\/ars.2021.0027","article-title":"Oxidative stress and endothelial dysfunction in Sepsis and acute inflammation","volume":"35","author":"Joffre","year":"2021","journal-title":"Antioxid Redox Signal"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1007\/s00134-018-5085-0","article-title":"The surviving Sepsis campaign bundle: 2018 update","volume":"44","author":"Levy","year":"2018","journal-title":"Intensive Care Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00134-007-0934-2","article-title":"Surviving Sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008","volume":"34","author":"Dellinger","year":"2008","journal-title":"Intensive Care Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2845","DOI":"10.1001\/jama.1977.03270310039005","article-title":"Albumin. 1. Background and use","volume":"237","author":"Tullis","year":"1977","journal-title":"JAMA"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1139\/cjpp-2019-0670","article-title":"The screening of albumin as a key serum component in preventing release of neutrophil extracellular traps by selectively inhibiting mitochondrial ROS generation","volume":"99","author":"Zheng","year":"2021","journal-title":"Can J Physiol Pharmacol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s13613-020-00697-1","article-title":"Role of albumin in the preservation of endothelial glycocalyx integrity and the microcirculation: a review","volume":"10","author":"Aldecoa","year":"2020","journal-title":"Ann Intensive Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1080\/17512433.2018.1412827","article-title":"Non-oncotic properties of albumin. A multidisciplinary vision about the implications for critically ill patients","volume":"11","author":"Ferrer","year":"2018","journal-title":"Expert Rev Clin Pharmacol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0199153","DOI":"10.1371\/journal.pone.0199153","article-title":"U-shape association of serum albumin level and acute kidney injury risk in hospitalized patients","volume":"13","author":"Thongprayoon","year":"2018","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1056\/NEJMoa1305727","article-title":"Albumin replacement in patients with severe sepsis or septic shock","volume":"370","author":"Caironi","year":"2014","journal-title":"N Engl J Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1007\/s00134-010-2039-6","article-title":"Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis","volume":"37","author":"Finfer","year":"2011","journal-title":"Intensive Care Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2247","DOI":"10.1056\/NEJMoa040232","article-title":"A comparison of albumin and saline for fluid resuscitation in the intensive care unit","volume":"350","author":"Finfer","year":"2004","journal-title":"N Engl J Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1186\/s13054-018-2169-8","article-title":"Septic shock-3 vs 2: an analysis of the ALBIOS study","volume":"22","author":"Vasques","year":"2018","journal-title":"Crit Care"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S0140-6736(18)30696-2","article-title":"Sepsis and septic shock","volume":"392","author":"Cecconi","year":"2018","journal-title":"Lancet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1177\/0884533617695243","article-title":"Sepsis: current definition, pathophysiology, diagnosis, and management","volume":"32","author":"Taeb","year":"2017","journal-title":"Nutr Clin Pract"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit Care Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1016\/j.jhep.2018.08.006","article-title":"Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation a randomized placebo-controlled trial","volume":"69","author":"Sol\u00e0","year":"2018","journal-title":"J Hepatol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/1757-7241-17-49","article-title":"IL-6 predicts organ dysfunction and mortality in patients with multiple injuries","volume":"17","author":"Frink","year":"2009","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.jcrc.2019.02.004","article-title":"Serum albumin as a risk factor for death in patients with prolonged sepsis: an observational study","volume":"51","author":"Takegawa","year":"2019","journal-title":"J Crit Care"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1177\/1099800419827600","article-title":"Serum albumin trend is a predictor of mortality in ICU patients with Sepsis","volume":"21","author":"Kendall","year":"2019","journal-title":"Biol Res Nurs"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"361","DOI":"10.2152\/jmi.61.361","article-title":"Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients: a retrospective study","volume":"61","author":"Ishida","year":"2014","journal-title":"J Med Investig"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1177\/000313481107701002","article-title":"Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer","volume":"77","author":"Lin","year":"2011","journal-title":"Am Surg"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"E58","DOI":"10.25011\/cim.v37i2.21087","article-title":"Sepsis, mitochondrial failure and multiple organ dysfunction","volume":"37","author":"Duran-Bedolla","year":"2014","journal-title":"Clin Invest Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"299","DOI":"10.3389\/fphys.2014.00299","article-title":"Unraveling the mysteries of serum albumin-more than just a serum protein","volume":"5","author":"Merlot","year":"2014","journal-title":"Front Physiol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1056\/NEJMra1208623","article-title":"Severe sepsis and septic shock","volume":"369","author":"Angus","year":"2013","journal-title":"N Engl J Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2355","DOI":"10.1097\/01.CCM.0000084846.45830.AA","article-title":"Twenty-five percent albumin prevents lung injury following shock\/resuscitation","volume":"31","author":"Powers","year":"2003","journal-title":"Crit Care Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1762","DOI":"10.1039\/c7pp00197e","article-title":"Spectroscopic investigations on the binding of an iodinated chlorin p(6)-copper complex to human serum albumin","volume":"16","author":"Sarbadhikary","year":"2017","journal-title":"Photochem Photobiol Sci"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"496","DOI":"10.3390\/ijms22094496","article-title":"Hypoalbuminemia as surrogate and culprit of infections","volume":"22","author":"Wiedermann","year":"2021","journal-title":"Int J Mol Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"s26","DOI":"10.2450\/2013.006s","article-title":"The demand for human albumin in Italy","author":"Vaglio","year":"2013","journal-title":"Blood Transfus"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"176","DOI":"10.5527\/wjn.v6.i4.176","article-title":"Causal relationship between hypoalbuminemia and acute kidney injury","volume":"6","author":"Wiedermann","year":"2017","journal-title":"World J Nephrol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.chest.2024.02.049","article-title":"International collaboration for transfusion medicine guidelines intravenous albumin guideline group. Use of intravenous albumin: a guideline from the international collaboration for transfusion medicine guidelines","volume":"166","author":"Callum","year":"2024","journal-title":"Chest"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1007\/s10096-019-03478-2","article-title":"Serum albumin is a strong predictor of sepsis outcome in elderly patients","volume":"38","author":"Arnau-Barr\u00e9s","year":"2019","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1080\/0886022X.2018.1489288","article-title":"Clinical characteristics of sepsis-induced acute kidney injury in patients undergoing continuous renal replacement therapy","volume":"40","author":"Cho","year":"2018","journal-title":"Ren Fail"},{"key":"ref42","first-page":"1180","article-title":"Albumin: physiologic and clinical effects on lung function","volume":"79","author":"Polito","year":"2013","journal-title":"Minerva Anestesiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1490838\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T05:38:47Z","timestamp":1747201127000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1490838\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,14]]},"references-count":42,"alternative-id":["10.3389\/fmed.2025.1490838"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1490838","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,14]]},"article-number":"1490838"}}